There is so much confusing information out there about the classification of repsonses to treatment.
Patient's initial diagnosis IGg Lambda Stage IIA (tipping to Stage III):, M spike was 2.79 g/dl,
bone marrow biopsy showed 41 % plasma cells , Immunophenotypic findings: cytoplasmic light chains at 10% of ficolled cells, Lambda light chains 97.4 (normal 5.7-26.3 m/l ) HIGH, Kappa/ Lambda ratio 0.08 (normal 0.26-1.65) LOW
Completed 4 rounds of Velcade/Revlimid/Dex
Current test results: M spike was 0.49 g/dl, bone marrow biopsy showed 3% plasma cells , Immunophenotypic findings: cytoplasmic light chains at .26% of ficolled cells, Lambda light chains and Kappa/Lambda ratio are now in normal range.
How would this response be classified?
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Re: How to figure out your response to treatment?
I believe the currently accept definitions for complete response (CR), stringent complete response (sCR), very good partial response (VGPR), partial response (PR), and so on are the ones summarized in Table 1 of this journal article:
http://bloodjournal.hematologylibrary.org/content/117/18/4691.full.pdf
So, a patient has achieved a complete response (CR) if:
Negative immunofixation of serum and urine, AND
Disappearance of any soft tissue plasmacytomas, AND
Less than 5% PCs in bone marrow.
A very good partial response (VGPR) has been achieved if
Serum and urine M-component detectable by immunofixation but not on electrophoresis, OR
At least a 90% reduction in serum M component plus urine M-component less than 100 mg/24 h
A partial response (PR) has been achieved if
At least a 50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 90% or to less than 200 mg/24 hours
If the serum and urine M-protein are not measurable, a decrease of at least 50% in the difference between involved and uninvolved FLC levels is required in place of the M-protein criteria
If serum and urine M-protein are not measurable, and serum free light assay is also
not measurable, at least a 50% reduction in bone marrow PCs is required in place of M-protein, provided baseline percentage was at least 30%
In addition to the above criteria, if present at baseline, at least a 50% reduction in the size of
soft tissue plasmacytomas is also required
Stable disease (SD) has been achieved if the criteria for CR, VGPR, PR, or progressive disease (PD) are not met.
The definition of progressive disease (PD) is rather involved; perhaps the Beacon Staff can do the additional copying and pasting at some point.
There is also a definition of stringent complete response (sCR), which is
Achieving complete (CR) as defined above, plus
Normal FLC ratio and
Absence of clonal PCs by immunohistochemistry or 2- to 4-color flow cytometry
Finally, there's also this footnote:
All response categories (CR, sCR, VGPR, PR, and PD) require 2 consecutive assessments made at any time before the institution of any new therapy; CR, sCR, VGPR, PR, and SD categories also require no known evidence of progressive or new bone lesions if radiographic studies were performed. VGPR and CR categories require serum and urine studies regardless of whether disease at baseline was measurable on serum, urine, both, or neither. Radiographic studies are not required to satisfy these response requirements. Bone marrow assessments need not be confirmed. For PD, serum M-component increases of more than or equal to 1 g/dL are sufficient to define relapse if starting M-component is at least 5 g/dL.
http://bloodjournal.hematologylibrary.org/content/117/18/4691.full.pdf
So, a patient has achieved a complete response (CR) if:
Negative immunofixation of serum and urine, AND
Disappearance of any soft tissue plasmacytomas, AND
Less than 5% PCs in bone marrow.
A very good partial response (VGPR) has been achieved if
Serum and urine M-component detectable by immunofixation but not on electrophoresis, OR
At least a 90% reduction in serum M component plus urine M-component less than 100 mg/24 h
A partial response (PR) has been achieved if
At least a 50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 90% or to less than 200 mg/24 hours
If the serum and urine M-protein are not measurable, a decrease of at least 50% in the difference between involved and uninvolved FLC levels is required in place of the M-protein criteria
If serum and urine M-protein are not measurable, and serum free light assay is also
not measurable, at least a 50% reduction in bone marrow PCs is required in place of M-protein, provided baseline percentage was at least 30%
In addition to the above criteria, if present at baseline, at least a 50% reduction in the size of
soft tissue plasmacytomas is also required
Stable disease (SD) has been achieved if the criteria for CR, VGPR, PR, or progressive disease (PD) are not met.
The definition of progressive disease (PD) is rather involved; perhaps the Beacon Staff can do the additional copying and pasting at some point.
There is also a definition of stringent complete response (sCR), which is
Achieving complete (CR) as defined above, plus
Normal FLC ratio and
Absence of clonal PCs by immunohistochemistry or 2- to 4-color flow cytometry
Finally, there's also this footnote:
All response categories (CR, sCR, VGPR, PR, and PD) require 2 consecutive assessments made at any time before the institution of any new therapy; CR, sCR, VGPR, PR, and SD categories also require no known evidence of progressive or new bone lesions if radiographic studies were performed. VGPR and CR categories require serum and urine studies regardless of whether disease at baseline was measurable on serum, urine, both, or neither. Radiographic studies are not required to satisfy these response requirements. Bone marrow assessments need not be confirmed. For PD, serum M-component increases of more than or equal to 1 g/dL are sufficient to define relapse if starting M-component is at least 5 g/dL.
Re: How to figure out your response to treatment?
Thanks. I still find it confusing based on the results I gave.
Re: How to figure out your response to treatment?
Does it really matter what category your are in? Based on the results that you posted after the rounds of treatment that you have had, you have responded very well to treatment. The more important factors are: How are you feeling, how is your quality of life compared to previously, what does your oncologist tell you, etc.?
It annoys me that people get so focused on details that don't really mean all that much. It's more important to focus on whether you are responding to treatment and how your quality of life is improving, or not. Yes, you should pay attention to numbers and whether they are improving, staying steady, or worsening. But, the other things don't really tell you all that much.
Just my personal feelings,
Nancy in Phila
It annoys me that people get so focused on details that don't really mean all that much. It's more important to focus on whether you are responding to treatment and how your quality of life is improving, or not. Yes, you should pay attention to numbers and whether they are improving, staying steady, or worsening. But, the other things don't really tell you all that much.
Just my personal feelings,
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: How to figure out your response to treatment?
Hello IMA,
Based on the information you have shared, "technically" you have achieved a partial response. The plasma cells in your bone marrow are less than 5% (this is a very positive finding). Your m-spike has fallen by 82%. Overall you are doing great ! It is possible that the m-spike would fall further in the next few weeks even if you weren't treated again. It takes several weeks for the m-spike to correlate with the marrow response.
You are getting the best available treatment combination (RVD) for newly diagnosed patients. I suspect that the m-spike will continue to fall into the very good partial remission (VGPR) level at least. Thank you for sharing your question with the Beacon. The lab tests will always be somewhat confusing to interpret.
Based on the information you have shared, "technically" you have achieved a partial response. The plasma cells in your bone marrow are less than 5% (this is a very positive finding). Your m-spike has fallen by 82%. Overall you are doing great ! It is possible that the m-spike would fall further in the next few weeks even if you weren't treated again. It takes several weeks for the m-spike to correlate with the marrow response.
You are getting the best available treatment combination (RVD) for newly diagnosed patients. I suspect that the m-spike will continue to fall into the very good partial remission (VGPR) level at least. Thank you for sharing your question with the Beacon. The lab tests will always be somewhat confusing to interpret.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: How to figure out your response to treatment?
Thanks Dr. Libby! This is one statement I didn't quite understand: "Immunophenotypic findings: cytoplasmic light chains at 10% of ficolled cells.". And it is good to know that the m-spike might continue to fall to correlate wit the bone marrow findings. Headed for stem cell transplant in November in any case.
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